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Organization
OHAEBOSIM MEDICAL CLINIC INC
Active
Organization
OHAEBOSIM MEDICAL CLINIC INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LINUS C OHAEBOSIM DO (OWNER PRESIDENT)
(316) 681-1901
Entity
Organization
Contact information
Practice address
2810 E 21ST STREET, WICHITA, KS 67214-2252
(316) 681-1901
(316) 618-7362
Mailing address
2810 E 21ST STREET, WICHITA, KS 67214-2252
(316) 681-1901
(316) 618-7362
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0516911
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100098690A
—
KS
01
—
4083832
AETNA
—
01
—
49202
BLUE SHIELD
KS
01
—
614790
FIRST GUARD
—
01
—
693
PHS
KS
Enumeration date
11/20/2006
Last updated
12/21/2011
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